Patients question quality of care at Salinas urology center

Stan Crowley was 77 when he learned he had prostate cancer. His urologist, Dr. Aytac Apaydin, told him he needed a special type of radiation available only in San Francisco, an unreasonable option given the Monterey County man would need daily treatments.

But Apaydin, co-owner of Salinas Valley Urology Associates, had a hopeful alternative. He could give Crowley hormone shots to stymie the tumor for a year while the physician finished building his state-of-the-art radiology center next to his office.

The shots, containing estrogen, left Crowley impotent and gave him unbearable hot flashes that left him standing outside on cold winter nights.

Then, 10 months into his regimen, his wife, Thora, was diagnosed with breast cancer. Her physician referred her for radiation to Dr. Esmond Chan, whose Salinas office was a few doors down from Apaydin's.

That's where she learned her husband could have been receiving the radiation he needed all along in Salinas.

Outraged, she and her husband had his records transferred to Chan, who successfully treated Stan Crowley for the prostate cancer by using the radiation treatment Apaydin had recommended — intensity-modulated radiation therapy, or IMRT. Stan died on Valentine's Day 2010 of unrelated skin cancer.

Thora Crowley seethes when she thinks back on Apaydin's care, remembering how they waited for hours in his crowded office for no reason. She said Apaydin called her the night her husband's records were transferred and asked why.

"Because you lied to us," she told him.

She said Apaydin denied her accusation and tried to explain away his medical advice.

"The out and out lies he told us, then to deny it and talk around it, we couldn't believe it," she said. "You trust people of authority like that when you're not in that field."

Chan confirmed the account and said he had many patients with similar complaints.

"We offered every bit the same treatment as Apaydin in 2007," said Chan, a radiation oncologist. "The treatment would not be in any way less than they got at Dr. Apaydin's."

Chan's former partner, Kevin Fisher, now practicing in Erie, Pa., said there was an unusual two-week period when his office received close to 20 faxed referrals from Apaydin's office — referrals for radiation treatment. He said the missives contained only the names, diagnoses and phone numbers of patients.

He said he did not know why Salinas Valley Urology suddenly referred the patients, but knew they were only a portion of those who had been awaiting treatment. When Apaydin and his partner, Dr. Stephen Worsham, completed their radiation facility at their offices in 2007, Fisher said, he heard from employees and radiation therapists that the new facility was immediately overwhelmed with more than 30 patients who had been waiting in the wings.

Apaydin "was selling them a huge lie" that there was no radiation available locally, Fisher said. "We were their radiation oncologists before they opened the facility."

Chan said Apaydin asked him and Fisher to run the new center when it was being planned, promising "there would be plenty of money in it" for them. Chan said they turned him down, believing the arrangement would present them with an unethical and legally questionable incentive to prescribe IMRT.

That potential conflict of interest is being investigated by the FBI and the Office of Inspector General at the U.S. Department of Health and Human Services, according to people who have been interviewed by investigators.

Apaydin, who has denied wrongdoing on any level through his attorney, has operated a profitable practice, according to his divorce records. He owns a $1.7 million oceanview home in Monterey with a garage big enough to hold his Ferrari 430, Porsche 911 and 2010 Land Rover. In court records last year, his wife accused him of using their money to take his girlfriend on lavish vacations and buy her a matching Land Rover.

Apaydin responded by boasting in court papers: "I earn personal income of more than $1 million a year from my medical practice. I do not need to dissipate community assets to support my lifestyle."

Chan said he never reported his concerns about Salinas Valley Urology Associates to the California Medical Board because they were based on hearsay and would be discounted as coming from a competitor. He believed any complaint should come from his patients, though none ever followed through to his knowledge.

Thora Crowley apparently came the closest.

Crowley, a retired teacher, got the necessary paperwork from Chan's staff to file a complaint with the medical board, but she abided her husband's wishes not to follow through.

She has now changed her mind. After reading news reports regarding a federal investigation into Apaydin and Salinas Valley Urology Associates, she has enlisted the help of her grandson, a newly minted attorney with a Los Angeles law firm that agreed to take her case.

More than a dozen former patients of Salinas Valley Urology have contacted The Herald in the wake of articles about the investigations. Like the Crowleys, they questioned the quality of care they received but either did not seek legal recourse or found out how difficult it is to do so.

Frank Ferrante, 68, of Seaside said radiation treatments he received at the clinic in 2009 left him with a serious long-term health problem. He contacted a Salinas attorney last year at this time to consider suing the clinic but was told the chance of winning was slim.

Ferrante was referred to the clinic by Monterey urologist David Flemming, who, sources said, paid $20,000 to $25,000 per month to lease space at Salinas Valley Urology.

A Bloomberg News article in November claimed Apaydin told urologists to send him lease payments so they could make money by referring patients to his business. Normally, a radiation lab would bill Medicare for services using its own billing code. Under the plan described by Bloomberg and people familiar with the arrangement, doctors who pay rent to Salinas Valley Urology are then able to bill Medicare for the IMRT regimens using their own billing codes, at a reimbursement rate of $30,000 or more per patient.

A 78-year-old King City man, who provided The Herald with copies of his medical records but declined to have his name published, was referred to Salinas Valley Urology in 2001 by a primary care doctor as a precaution because of his age.

After three to four biopsy procedures, he said, Worsham advised him to have his prostate removed. The records indicate Worsham made the recommendation in January 2001 and listed Apaydin as an assistant.

The man said he asked for a second opinion and Worsham offered to "help him" with it, but the man declined. Instead, he connected with a friend who was able to get him into the urology center at UCLA.

He said doctors there told him, after a review of his biopsies, he did not require treatment.

Nearly 12 years later, the man has received no cancer treatment and is still healthy. He said he would not seek action against Salinas Valley Urology.

"I'm not that kind of person," he said.

Fisher, the Pennsylvania physician, said research supports UCLA's conservative approach. Virtually every man in his late 70s or 80s has prostate cancer, he said. And while many physicians agree IMRT is appropriate in younger patients with aggressive cancer, the widely accepted National Comprehensive Cancer Network's guidelines call for non-intrusive monitoring for older men with biopsy "Gleason scores" less than 7.

Multiple older patients who spoke to The Herald said doctors at Salinas Valley Urology recommended IMRT when their Gleason scores were only 6.

"These are the kinds of cancers that virtually every man in his 80s would have," said Fisher.